Learning curve for arteriovenous fistula creation

Objective: Amount of time and number of procedures required in junior surgeon (JS) to achieve arteriovenous fistula (AVF) patency rate of surgeon with 20 years of experience. Methods: A single-center, retrospective, case-control study of AVF primary patency rate at 1 year postoperatively was observed among junior and experienced surgeon (ES) over a 4-year period. Fistula was created by terminolateral anastomosis in a fashion of continuous suture with nonabsorbable double-armed 7-0 monofilament. Maturation was grounded on the physical examination and fistula ultrasound 6 weeks postoperatively. Results: One hundred and twelve patients, 65% male and 35% female, were included in the study in 4 year period, 2015-2018. There were 51% radiocephalic and 49% brachiocephalic fistulas constructed by JS. Patency rate for JS was 66% overall, combining 64% for radiocephalic and 67% for brachiocephalic, compared to ESs 79%, performing only brachiocephalic fistulas. In the first 3 years, patency rate was 63%, 60%, and 66%, while significant improvement was accomplished in the the 4th year with patency rate of 75%. Average time for hemodialysis initiation was 88 days postoperatively. Conclusions: Three years and approximately 60 procedures are required for JS to produce results comparable to ES in creation of AVF.